Which CT findings are characteristic of intracranial hemorrhage in pediatric headache?

CT scanning is the best initial study to demonstrate intracranial hemorrhage from malignant hypertension or vascular lesions. However, CT scan findings are positive in only about 90% of patients with subarachnoid hemorrhage, so a lumbar puncture should be performed despite unremarkable CT scan findings in patients thought to have a subarachnoid hemorrhage.

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Trigeminovascular system. The trigeminal nerve fibers around basal cerebral and meningeal vessels are triggered (various stimuli are possible), and a vicious cycle starts in which the nerve terminals release calcitonin gene-related peptide (CGRP), substance P, vasoinhibitory peptide (VIP), and other mediators of local neurogenic inflammation and vasodilatation. The latter further stimulates the nerve endings. On the other end of the nerve, painful messages are transmitted toward central centers, including thalamus and cortex, and the sensation of pain arises. Modern drugs, such as the triptans, act at 3 levels, via 5-HT 1 B and D receptors; they vasoconstrict the vessels, reduce the release of the above-mentioned mediators, and decrease the central transmission of pain impulses.

Disclosure: Received consulting fee from Zogenix for board membership; Received consulting fee from MAPP for review panel membership; Received grant/research funds from GlaxoSmithKline for research investigator; Received consulting fee from Allergan for board membership; Received consulting fee from Allergan for consulting.

Chief Editor

George I Jallo, MD Professor of Neurosurgery, Pediatrics, and Oncology, Director, Clinical Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine